The Integrated Management of Childhood Illness protocol (IMCI) is a promising strategy to reduce childhood mortality, but experience implementing it suggested that clinical training, while essential, was not sufficient for its success: strengthening health systems, such as supervision and drug supply, is also needed. This article in BMC International Health and Human Rights presents the results of Niger’s IMCI implementation, which started by strengthening district-level supervision and improving the availability of child survival drugs through cost recovery. The article concludes that these steps helped but that a later evaluation should assess the impact of IMCI over the long term.